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EP1628596B1 - Stents mit angebrachten schlaufen - Google Patents

Stents mit angebrachten schlaufen Download PDF

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Publication number
EP1628596B1
EP1628596B1 EP04753163A EP04753163A EP1628596B1 EP 1628596 B1 EP1628596 B1 EP 1628596B1 EP 04753163 A EP04753163 A EP 04753163A EP 04753163 A EP04753163 A EP 04753163A EP 1628596 B1 EP1628596 B1 EP 1628596B1
Authority
EP
European Patent Office
Prior art keywords
strand
strands
couplings
prosthesis
coupling
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
EP04753163A
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English (en)
French (fr)
Other versions
EP1628596A1 (de
Inventor
Gary J. Leanna
Paul K. Norton
Peter Brady
Dean Molloy
Michael E. Zupkofska
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Boston Scientific Ltd Barbados
Original Assignee
Boston Scientific Ltd Barbados
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Filing date
Publication date
Application filed by Boston Scientific Ltd Barbados filed Critical Boston Scientific Ltd Barbados
Priority to EP10012156.5A priority Critical patent/EP2286771B1/de
Publication of EP1628596A1 publication Critical patent/EP1628596A1/de
Application granted granted Critical
Publication of EP1628596B1 publication Critical patent/EP1628596B1/de
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • A61F2/88—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure the wire-like elements formed as helical or spiral coils
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • A61F2/90—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
    • D—TEXTILES; PAPER
    • D04—BRAIDING; LACE-MAKING; KNITTING; TRIMMINGS; NON-WOVEN FABRICS
    • D04C—BRAIDING OR MANUFACTURE OF LACE, INCLUDING BOBBIN-NET OR CARBONISED LACE; BRAIDING MACHINES; BRAID; LACE
    • D04C1/00—Braid or lace, e.g. pillow-lace; Processes for the manufacture thereof
    • D04C1/06—Braid or lace serving particular purposes
    • D—TEXTILES; PAPER
    • D04—BRAIDING; LACE-MAKING; KNITTING; TRIMMINGS; NON-WOVEN FABRICS
    • D04C—BRAIDING OR MANUFACTURE OF LACE, INCLUDING BOBBIN-NET OR CARBONISED LACE; BRAIDING MACHINES; BRAID; LACE
    • D04C3/00—Braiding or lacing machines
    • D04C3/48—Auxiliary devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2002/9534—Instruments specially adapted for placement or removal of stents or stent-grafts for repositioning of stents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0004—Rounded shapes, e.g. with rounded corners
    • A61F2230/0013—Horseshoe-shaped, e.g. crescent-shaped, C-shaped, U-shaped
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0017—Angular shapes
    • D—TEXTILES; PAPER
    • D10—INDEXING SCHEME ASSOCIATED WITH SUBLASSES OF SECTION D, RELATING TO TEXTILES
    • D10B—INDEXING SCHEME ASSOCIATED WITH SUBLASSES OF SECTION D, RELATING TO TEXTILES
    • D10B2509/00—Medical; Hygiene
    • D10B2509/06—Vascular grafts; stents
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
    • Y10T29/00—Metal working
    • Y10T29/49—Method of mechanical manufacture
    • Y10T29/49826—Assembling or joining
    • Y10T29/49863—Assembling or joining with prestressing of part
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
    • Y10T29/00—Metal working
    • Y10T29/49—Method of mechanical manufacture
    • Y10T29/49826—Assembling or joining
    • Y10T29/49906—Metal deforming with nonmetallic bonding
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
    • Y10T29/00—Metal working
    • Y10T29/49—Method of mechanical manufacture
    • Y10T29/49826—Assembling or joining
    • Y10T29/49908—Joining by deforming

Definitions

  • the present invention relates to stents and other body insertable devices of open frame construction, and more particularly to radially expandable or radially self-expanding prostheses.
  • stents such as disclosed in U.S. Patent No. 4,655,771 (Wallsten ).
  • This type of prosthesis shown in Figure 1 , is a tubular, braided structure formed of thread elements wound helically in opposite directions.
  • the stent is shown in a relaxed state, i.e. in the configuration assumed when the stent is subject to no external stress.
  • the stent is elastically compressible to a reduced-radius, axially elongated state to facilitate an intraluminal delivery of the stent to an intended treatment site.
  • the stent is released for radial self-expansion into contact with surrounding tissue, for example a blood vessel wall.
  • the stent does not fully expand, but instead remains under a slight elastic compression, so that an internal elastic restoring force tends to anchor the stent within the vessel, and maintain vessel patency.
  • the thread elements also called strands or filaments, form multiple intersections or crossing points, each including a pair of oppositely directed strands.
  • oppositely directed strands are connected in pairs to form end terminations or strand couplings.
  • the strands can be formed of metal, in which case the end terminations can be formed by welding the strands or by twisting the pairs of strands together, preferably augmented with welds.
  • the strands can be formed of polymeric materials, with end terminations formed by fusing the strands or boding them with an adhesive.
  • a malleable metal such as tantalum can be wound or braided into a plastically deformable prosthesis.
  • This device is capable of maintaining a reduced-radius state on its own to facilitate delivery, but requires a balloon or other implement to expand the prosthesis into contact with surrounding tissue at the treatment site.
  • Figure 2 illustrates part of a prosthesis formed according to an alternative construction in which the strands are wound instead of braided, to form generally hexagonal cells. Adjacent cells have coextensive regions, along which pairs of the strands are wrapped helically about one another. This construction is further illustrated and explained in U.S. Patent No. 5,800,519 (Sandock ).
  • Figure 3 illustrates a prosthesis formed according to another construction, illustrated and discussed in U.S. Patent No. 6,264,689 (Colgan ). Like the stent in Figure 2 , this stent features structural strands wound to form multiple helical cells. However, it differs from the device of Figure 2 , in that at some of the junctions of strands, the strands simply cross one another, rather than being twisted helically about one another.
  • the strands are bent to form a plurality of loops 1. These loops form relatively flexible, blunt end terminations, desirable because they more readily adjust to features of the body lumen in which the prosthesis is deployed, and they present minimal risk of injury to the surrounding tissue. Conversely, at the proximal end, pairs of strands are twisted together and ball welded at the ends, to form proximal end terminations 2.
  • the devices in Figures 1 and 2 may also be formed with distal and proximal end terminations comprising bends and twisted pairs, respectively.
  • any of these devices may be formed with twisted end terminations at both the proximal and distal ends.
  • terminations at the proximal end, or at both ends may be formed by welding the pairs of strands together, without twisting.
  • the welded or twisted end terminations are disadvantageous. As compared to the rest of the prosthesis, the welded or twisted end terminations are relatively stiff and rigid, and thus more likely to poke surrounding tissue, rather than bend to accommodate the tissue. Because of the abrupt ends of the welded or twisted end terminations, the poking occasioned by their relative stiffness presents a risk of damage to tissue. Consequently, any positional adjustment of a deployed stent, particularly in the direction that the welded or twisted end terminations extend, is difficult. Another problem encountered with the twisted or welded end terminations is that adjacent twisted wire pairs may interlock when the stent is radially compressed into the delivery state, and then interfere with radial expansion of the stent at a treatment site.
  • WO 01/35864 discloses a multi-section filamentary stent comprising a braided section, which is a cylindrical mesh of a first set of filaments, connected to at least one wound section comprising a second set of one or more filaments having a repeating configuration with a bent portion.
  • the two sections are connected by at least one continuous filament extending into both sections and may be connected by a weld, a suture, a common graft, an overlapping portion of the two sections, or one or more filaments of one section looping through portions of the other section.
  • the stent may comprise a first section, having a braided first stent architecture with a first flexibility and a first radial force, and a second section, having a non-braided second stent architecture with a second flexibility less than the first flexibility and a second radial force greater than the first radial force, in which at least one continuous filament is integral to both the first and second sections.
  • WO 2004/045461 published on 03.06.2004 is part of the prior art under the provisions of Article 54(3) EPC and discloses a stent with bends at one end and strand couplings connected by closure members at the other end. The number of bends equals the number of closure members.
  • Another object is to provide a prosthesis with looped end terminations that permit radial compression of the prosthesis to a smaller diameter for intraluminal delivery.
  • a further object is to provide a process for fabricating a stent with the elongate strands or strand segments selectively shaped at one or both ends of the stent to provide relatively blunt and flexible end terminations.
  • Yet another object is to provide a stent or other prosthesis that is more readily adjustable and retrievable after its deployment in a blood vessel or other body lumen.
  • an implantable prosthesis including a plurality of elongate strands interbraided to form an open-frame tubular
  • each pair of associated strand couplings includes first and second strand couplings, one of the strands of the first strand coupling being longer than the other strand to provide a
  • looped end terminations formed according to the invention although larger than the conventional looped end terminations, permit a similarly sized stent to be radially contracted to a smaller size, due to the lower number of looped end terminations.
  • each pair of associated strand couplings includes a first strand coupling in which the ends of the coupled strands substantially coincide, and a second strand coupling in which one of the strands extends beyond the other to provide a strand extension of a predetermined length.
  • the strand extension is selectively shaped and connected to the first strand coupling, preferably by welding, to provide the loop segment.
  • closure members and strand couplings include fusion bonds, adhesives, and tubes surrounding adjacent portions of the closure member and strand coupling.
  • each closure member is somewhat U-shaped, comprising opposite legs, each coupled to one of the paired strand couplings, and a medial region between the two legs.
  • the medial region can be shaped to incorporate two inclined side sections and a curved apex between the side sections. As the tubular structure is radially contracted, each closure member tends to bend primarily at the apex, and along regions of slight curvature between the side sections and legs.
  • end closure members in accordance with the present invention can be employed to enhance virtually any open-frame structure having strand couplings at one of its ends, to render that end more flexible and reduce the risk of trauma to surrounding tissue.
  • Another aspect of the present invention is a process for forming a body implantable device with at least one atraumatic end, including: winding a plurality of elongate structural strands to form an open-frame tubular structure having first and second opposed ends; wherein said winding includes elongate strands at said first opposed end of the tubular structure to form loop end terminations at said first opposed end; winding the plurality of elongate strands along said second opposed end, integrally coupling different ones of the elongated structural strands together along respective end regions thereof to form a plurality of strand couplings at said second opposed end, wherein each of the strand couplings includes at least two of the strands; and shaping an elongate strand segment into a loop segment having an arcuate region, and forming a connection of the strand segment with an associated pair of the strand couplings, with the arcuate region disposed axially outwardly of the associated strand couplings characterised in that the number of loop segments at said second
  • a stent or other open-frame prosthesis is fashioned with flexible, blunt, atraumatic ends, so that after its deployment in a body lumen, the device is movable without the risk of injury to surrounding tissue.
  • devices constructed according to the invention are compressible radially into smaller diameters to facilitate their intraluminal delivery.
  • the looped end terminations described herein can be formed at either end or both ends of stents and other open-frame prostheses.
  • FIG. 4 a stent 16 fabricated according to the present invention, and part of a device 18 used to intraluminally deliver the stent to an intended treatment site and deploy the stent at the treatment site.
  • the device includes an elongate, flexible outer catheter 20 having a distal end region 22, along which the outer catheter surrounds stent 16 and maintains the stent in a reduced-radius, axially elongated delivery state to facilitate an intraluminal delivery of the stent to the treatment site.
  • Stent 16 is contained within a lumen 24, which runs substantially the entire length of the outer catheter.
  • a deployment member 28 is fixed to inner catheter 26, proximally of stent 16.
  • Inner catheter 26 includes a lumen (not shown) to accommodate a guidewire 30, which is used to guide the inner and outer catheters to the treatment site.
  • Stent 16 is composed of oppositely directed helically wound strands or filaments 32 that intersect one another to form multiple intersections or crossing points.
  • Strands 32 are interbraided in a one-over-one-under pattern.
  • strands 32 are bent to form distal end loops 33.
  • the strands are formed of a superelastic alloy of titanium and nickel sold under the brand name Nitinol.
  • suitable strand materials include cobalt-based alloys such as those sold under the brand names Elgiloy or Phynox, MP35N alloy, and certain stainless steels.
  • Suitable nonmetallic alternatives include polymers, for example polyester and polyethylene terephthalate (PET).
  • Strands 32 are resilient, and when maintained as shown in Figure 1 store an elastic restoring force.
  • stent 16 When released from outer catheter 20, stent 16 self-expands under the restoring force, toward a normal or relaxed state shown in Figure 5 that stent 16 assumes when under no external stress.
  • stent 16 shortens axially as it expands radially.
  • stent 16 engages surrounding tissue before it expands fully to the relaxed state.
  • the deployed stent exerts a radially outward force against the tissue that tends to anchor the stent at the treatment site.
  • One of the challenges to the physician using device 18 is to accurately place the stent. Accurate placement is made more difficult by the axial shortening of the stent as it enlarges radially. Once the stent is fully deployed, it is contiguous with and frequently partially embedded into the surrounding tissue. As a result, it is difficult to adjust the position of the stent to correct a less than accurate placement. With prostheses constructed as shown in Figures 1-3 , proximal stent adjustment is particularly difficult because of the stiff welded and/or twisted strand couplings with abrupt proximal ends that present the risk of injury to tissue.
  • the proximal end of stent 16 is formed with a series of loop segments. Specifically, six loop segments 34-44 are formed in conjunction with twelve strand junctions or couplings 46. Each loop segment acts as a closure member, cooperating with its associated pair of strand couplings and the coupled strands to form a closed loop end termination. Each loop segment is formed with an extension of one of the coupled strands.
  • Figure 6 shows a strand junction 46a including strands 32a and 32b, coupled to each other by a weld 48. Similarly, strands 32c and 32d are joined by a weld 50 to form a strand junction 46b.
  • Strand 32b is longer than the other strands by a predetermined length, to provide a proximal strand extension or portion 52 extending beyond the other strands, which is shaped to provide loop segment 34.
  • Loop segment 34 has several discrete elements, including opposed axially extending legs 54 and 56, opposite inclined linear side sections 58 and 60, a curved proximal end apex 62, and a pair of arcuate sections 64 and 66, each between one of the legs and side sections.
  • a portion of leg 56 is axially aligned with junction 46b, and is connected to that coupling by a weld 68.
  • the remaining loop segments 34-44 are formed in the same manner.
  • Stent 16 after deployment can be moved proximally along the body lumen without the risk of trauma to the surrounding tissue.
  • Apex 62 and its counterparts on the other loop segments provide smooth, rounded, blunt proximal end terminations with no tendency to poke or cut into tissue as the stent is moved.
  • the loop segments are considerably more flexible than the strand end junctions, regardless of whether the strands are twisted. This is primarily due to strands 32, which are bendable about tangential axes both proximally and distally of junctions 46 to carry apex 62 and its counterparts radially inward. This affords a localized (proximal) radial contraction of the stent to facilitate pulling the stent proximally along the lumen while the majority of the stent remains in contact with surrounding tissue.
  • Apex 62 further is bendable about radial axes, to bring the legs and side sections closer to one another during radial contraction.
  • Arcuate sections 64 and 66 also are bendable about radial axes, although unlike the apex, they bend in the direction of increasing radii of curvature during radial contraction of the stent. As a result, legs 54 and 56 tend to retain their axial orientation during radial contraction of the stent.
  • loop segments 34-44 are arranged symmetrically about the proximal end of the stent, equally angularly spaced apart from one another. Radial contraction of stent 16 not only bends each loop segment into a narrower configuration, but also reduces the gaps between adjacent loop segments. The extent of permitted radial contraction is limited by the amount of bending permitted in each loop segment, particularly at the apex.
  • a salient feature of the present invention is the association of single loop segments with pairs of strand junctions, which reduces the number of loops by one-half, as compared to the conventional loops formed by bending the strands at one end of the stent.
  • the proximal end of stent 16 as compared to its distal end, is contractible to a smaller diameter.
  • Stent 16 is fabricated, first by helically winding strands 32 onto a shaping mandrel 70. While Figure 8 shows only one strand 32a wound about the mandrel, it is to be appreciated that all of the strands are wound simultaneously onto the mandrel to form the braided structure. From a first end 72, strand 32a is wound helically about mandrel 70 until it approaches a remote end 76 of the mandrel, where the strand is trained about a pin 78 to form one of bends 33. Then, the strand is wound helically about the mandrel in the opposite direction, to a proximate end 82. Each strand forms two helical runs or passes over the axial length of the stent. In stent 16, twelve strands form twenty-four such runs. At the proximal end of the mandrel, the ends of the strands form twelve junctions 46.
  • Figure 9 shows two of the strand junctions, representing four strand ends, disposed on mandrel 70.
  • Strand 32b includes portion 52 extending axially beyond the rest of the strands.
  • Three pins 84 are fixed to the mandrel, axially outwardly of the strand couplings.
  • Extension 52 of strand 32b is bent about each of pins 84. Its free end 86 is positioned against strand 32c, then attached to strand 32c by welding.
  • mandrel 70 is placed in an oven (or the mandrel is heated) to a heat the strands to a heat set temperature.
  • the heat set temperature while much lower than the melting temperature for the strand material, is sufficient to relax the strands such that they are amenable to shaping.
  • each strand retains its helical shape, and the strands cooperate to determine the relaxed-state tubular shape of the braided structure.
  • Shape memory alloys such as Nitinol are particularly well suited for this process.
  • Figure 11 is a view similar to that in Figure 6 , showing part of a stent 90 with an alternative loop forming arrangement in which a strand 92a (rather than 92b) is longer than the other strands and provides the loop segment.
  • a free end 94 of strand 92a is positioned adjacent strand 92d, rather than 92c, then welded to a junction 96b as before.
  • This can be conveniently considered and "outside-to-outside” connection, as opposed to the "inside-to-inside” connection shown in Figure 6 .
  • outside-to-outside connections form slightly wider loop segments.
  • Figure 12 shows another alternative arrangement in which hypotubes are used in lieu of welds to secure adjacent portions of the strands.
  • the connections for one of the loop segments are formed by sliding a hypotube 98 over strands 100a and 100b, sliding a hypotube 102 over strands 100c and 100d, shaping an extension 104 of strand 100b and inserting its free end into hypotube 102, then crimping the hypotubes to provide a friction fit that anchors the strands to one another.
  • the hypotubes preferably are formed of steel.
  • tubes 98 and 102 can be formed of elastomeric materials and provide a friction fit, augmented with an adhesive if desired.
  • tubes 98 and 102 are heat shrunk onto the adjacent strands.
  • Figure 13 shows part of the proximal end of a polymeric stent 106, specifically polymeric strands 108a and 108b forming a junction110a, and polymeric strands 108c and 108d, forming a junction 110b.
  • the strand junctions are formed by fusion bonding.
  • an extension 112 of strand 108b is shaped to provide a loop segment, and its free end is connected to strand 108c, again by fusion bonding.
  • the fusion bonds are preferably formed simultaneously, although they can be formed serially.
  • Figure 14 illustrates a proximal end region of an alternative stent 114 in which strands 116a and 116b are welded to form a strand coupling 118a, and strands 116 and 116d are welded into a strand coupling 118b. None of strands 16a-d extends axially beyond the others. Thus, none of strands 116 is shaped to provide end closure. Instead, loop closure is provided by a generally U-shaped strand segment 120.
  • the strand segment includes counterparts to the elements described in connection with loop segment 34a, including opposed legs 122 and 124, side sections 126 and 128, an apex 130, and arcuate sections 132 and 134.
  • Strand segment 120 is attached to strand couplings 118a and 118b, by any of the previously mentioned connecting methods. This approach requires connections at both strand couplings. However, it facilitates using different materials for strands 116 and for strand segments 120 if desired, and also allows attachment of the strand segments to a previously formed stent.
  • Figure 15 illustrates an alternative embodiment open-frame prosthesis 136, in which elongate strands138 are wound about a mandrel to form multiple, generally hexagonal cells 140. As indicated in the enlargement, adjacent cells are joined by coextensive regions 142 along which strands 138 are twisted helically about one another. At a distal end 144 of the prosthesis, the strands are bent to provide loops 146. A plurality of radiopaque markers 148 are fixed to the loops.
  • pairs of strands 138 are welded together to form strand couplings.
  • Each pair of adjacent couplings includes one strand with an extended portion shaped into a loop segment 152, which in turn is welded to the adjacent strand coupling of the pair.
  • Radiopaque markers 153 are fixed near loop segments 152, and may be fixed to the loop segments.
  • Strands 138 form multiple intersections 154 in addition to coextensive regions 142.
  • Loop segments 152 can be arcuate as shown, or be shaped to more closely resemble loop segments 34-44.
  • Figure 16 shows a braided prosthesis 156 formed of two sets of oppositely directed helically wound strands 158. At both ends of prosthesis 156, pairs of the strands are welded or otherwise secured together to form proximal end strand couplings 160, and distal end strand couplings 162.
  • the prosthesis includes a plurality of proximal end loop segments 164. Each loop segment 164 is connected to an associated pair of the strand couplings 160.
  • Prosthesis 156 includes a plurality of distal end loop segments 166, each coupled to an associated pair of the distal end strand couplings.
  • the embodiment of Fig.16 does not constitute a part of the subject matter claimed by the present invention.
  • FIG. 17 illustrates a proximal end region of prosthesis 156, and a positioning device 168 spaced apart proximally from the prosthesis.
  • Device 168 includes an elongate flexible shaft 170, a distal portion of which is shown.
  • a tine 172 at the distal end of shaft 170 extends away from the shaft, inclined proximally and radially outward.
  • shaft 170 is moved distally to position its distal end in proximate axial alignment with loop segments 164, the shaft is manipulated to direct tine 172 through one of the loops. Then the shaft is moved proximally to carry tine 172 into engagement with an associated loop segment 164, whereupon further proximal travel of the shaft pulls prosthesis 156 in the proximal direction.
  • prosthesis 156 may be pulled proximally, which causes localized axial elongation.
  • the axial elongation radially contracts prosthesis 156 along its proximal end region near the loop segments. This facilitates proximal movement of the prosthesis by pulling the prosthesis radially inward at least slightly away from the surrounding tissue.
  • the frictional hold is overcome and the entire prosthesis moves proximally, although a distal portion of the prosthesis may remains engaged with surrounding tissue. This is beneficial, in that the frictional "drag" allows a more incremental, accurate adjustment of prosthesis position.
  • device 168 can be replaced with a device with several tines or shafts, to simultaneously pull several, or all, of the loop segments.
  • a tether can be threaded through loop segments 164, such that proximally pulling the tether brings the loop segments radially inward and closer together in cinch fashion.
  • device 168 or the aforementioned tether can be used not only for incremental proximal adjustments, but for retrieval of prosthesis 156.
  • a device similar to device 168, with a tine preferably inclined radially outwardly in the distal direction, could be used to engage one of distal end loop segments 166.
  • loop segments are attached to associated pairs of strand end couplings to reduce the risk of trauma to tissue, and provide a prosthesis that is radially compressible to a smaller diameter to facilitate intraluminal delivery.
  • the looped ends eliminate the potential for adjacent twisted strand pairs to interlock when the prosthesis is compressed to its delivery state, ensuring a more reliable radial expansion of the prosthesis when deployed at the treatment site.
  • the looped ends further facilitate incremental repositioning of the prosthesis after its deployment.

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Claims (17)

  1. Eine implantierbare Prothese (16), aufweisend:
    eine Vielzahl gestreckter Drähte (32), die miteinander verflochten sind, um eine röhrenförmige Struktur mit einem offenen Rahmen mit entgegengesetzten ersten und zweiten atraumatischen Enden zu bilden, wobei die röhrenförmige Struktur radial ausdehnbar und zusammenziehbar ist, zwischen einem Zustand mit einem vergrößerten Radius und einem Zustand mit einem verkleinerten Radius, wobei die Drähte (32) gebogen sind, um Bögen (33) an den ersten atraumatischen Enden zu bilden; wobei andere der gestreckten Drähte (32) einstückig miteinander gekoppelt sind entlang ihrer jeweiligen Endbereiche, um eine Vielzahl von Drahtkupplungen (46a, 46b) entlang dem zweiten atraumatischen Ende der röhrenförmigen Struktur zu bilden; und
    eine Vielzahl von Schließbauteilen, die an dem zweiten atraumatischen Ende angeordnet sind, wobei jedes der Vielzahl von Schließbauteilen mit einem Paar zugehöriger Drahtkupplungen (46a, 46b) verbunden ist und sich zwischen den dazugehörigen Drahtkupplungen (46a, 46b) erstreckt, um ein Schlaufensegment (34, 36, 38, 40, 42, 44) zu bilden, welches axial auswärts von den zugehörigen Drahtkupplungen gerichtet ist, und jedes der Vielzahl von Schließbauteilen mit einem unterschiedlichen Paar der Drahtkupplungen (46a, 46b) verbunden ist, wobei jedes Paar der dazugehörigen Drahtkupplungen (46a, 46b) erste und zweite Drahtkupplungen einschließt, wobei einer der Drähte der ersten Drahtkupplung länger als der andere Draht ist, um eine Drahtverlängerung mit einer vorbestimmten Länge bereitzustellen, und wobei die Drahtverlängerung beliebig geformt und mit der zweiten Drahtkupplung verbunden ist, um das Schließbauteil in Form eines Schlaufensegments (34, 36, 38, 40, 42, 44) bereitzustellen;
    dadurch gekennzeichnet, dass
    die Anzahl der Schließbauteile an dem zweiten atraumatischen Ende die Hälfte der Anzahl der Bögen (33) an dem ersten atraumatischen Ende ist.
  2. Prothese nach Anspruch 1, wobei:
    die Drahtkupplungen (46a, 46b) entlang des Umfangs des ausgewählten Endes der röhrenförmigen Struktur angeordnet sind und im wesentlichen mit gleichen Winkeln voneinander beabstandet sind.
  3. Prothese nach Anspruch 1, wobei:
    jedes Schlaufensegment (34, 36, 38, 40, 42, 44) im wesentlichen eine U-Form aufweist.
  4. Prothese nach Anspruch 1, wobei:
    jedes der Vielzahl von Schließbauteilen mit zumindest einem seiner dazugehörigen Paare von Drahtkupplungen (46a, 46b) durch eine Verbindung verbunden ist, die ausgewählt ist aus der Gruppe, die besteht aus: Verschweißungen, Verschmelzungen, Verklebungen und Röhren, die angepasst sind, um benachbarte Abschnitte des Schließbauteils und eine benachbarte Drahtkupplung zu umgeben.
  5. Prothese nach Anspruch 1, wobei:
    jedes Schlaufensegment im allgemeinen U-förmig ist, und weiterhin gegenüberliegende Beine aufweist, einschließlich eines Beins, welches einstückig mit jeder Drahtkupplung des verbundenen Paars ist, und weiterhin einen bogenförmigen Zwischenbereich zwischen den Beinen aufweist.
  6. Prothese nach Anspruch 5, wobei:
    der Zwischenbereich zwei geneigte Seitensektionen aufweist, und eine gebogene Spitze zwischen den zwei Seitensektionen.
  7. Prothese nach Anspruch 1, wobei:
    die Drähte erste und zweite Sätze von Drähten aufweisen, die helixförmig in gegenüberliegende Richtungen gewickelt sind, um mehrere Schnittpunkte zu bilden.
  8. Prothese nach Anspruch 1, wobei:
    die ersten und zweiten Sätze von Drähten in Form eines Einsüber-/eins-unter-Musters miteinander verflochten sind.
  9. Prothese nach Anspruch 1, wobei:
    die röhrenförmige Struktur radial-elastisch zusammenziehbar ist auf den verringerten Radiuszustand, und selbstausdehnbar zu dem vergrößerten Radiuszustand ist.
  10. Verfahren zum Bilden einer in einen Körper implantierbaren Vorrichtung (16) mit zumindest einem atraumatischen Ende, aufweisend:
    Aufwickeln einer Vielzahl von gestreckten strukturellen Drähten (32), um eine röhrenförmige Struktur mit einem offenen Rahmen mit ersten und zweiten gegenüberliegenden Enden zu bilden, wobei
    die Wicklungen gestreckte Drähte (32) an dem ersten gegenüberliegenden Ende der röhrenförmigen Struktur aufweisen, um geschlossene Schlaufenabschlüsse (33) an dem ersten gegenüberliegenden Ende zu bilden;
    Aufwickeln der Vielzahl gestreckter Drähte (32) entlang des zweiten gegenüberliegenden Endes, einstückiges Miteinanderkoppeln von verschiedenen gestreckten strukturellen Drähten (32) entlang ihrer jeweiligen Endbereiche, um eine Vielzahl von Drahtkupplungen (46a, 46b) an dem zweiten gegenüberliegenden Ende zu bilden, wobei jede der Drahtkupplungen (46a, 46b) zumindest zwei der Drähte (32) aufweist; und
    Formen eines gestreckten Drahtsegments zu einem Schlaufensegment (34, 36, 38,40,42,44) mit einem Bogenbereich (69, 62, 64), und Bilden einer Verbindung des Drahtsegments mit einem dazugehörigen Paar von Drahtkupplungen (46a, 46b), wobei der Bogenbereich axial auswärts von den dazugehörigen Drahtkupplungen (46a, 46b) angeordnet ist;
    dadurch gekennzeichnet, dass
    die Anzahl von Schlauchsegmenten (34, 36, 38, 40, 42, 44) an dem zweiten gegenüberliegenden Ende die Hälfte beträgt, verglichen mit den Schlaufenendabschlüssen (33) an dem ersten gegenüberliegenden Ende.
  11. Verfahren nach Anspruch 10, worin:
    jede der Kupplungen durch Bilden erster und zweiter Drahtkupplungen von jedem Paar gebildet wird, und Bereitstellen von einem der Drähte an der ersten Drahtkupplung mit einem Drahtabschnitt einer vorbestimmen Länge, die sich axial auswärts über die anderen Drähte des Paars hinaus erstreckt, und
    beliebiges Formen des Drahtabschnitts, um ein Drahtsegment bereitzustellen, und Verbinden eines freien Endes des Drahtabschnitts mit der zweiten Drahtkupplung.
  12. Verfahren nach Anspruch 10, umfassend:
    Bilden der Verbindung mit dem dazugehörigen Paar von Drahtkupplungen durch Verwenden eines Verbindungsverfahrens,
    welches ausgewählt ist aus einer Gruppe, die besteht aus:
    Verschweißungen, Verschmelzungen, Verklebungen, und Röhren, die angepasst sind, um benachbarte Abschnitte des Schließbauteils und eine benachbarte Drahtkupplung zu umgeben.
  13. Verfahren nach Anspruch 10, worin:
    Formen des Drahtsegments ein Formen eines gestreckten Drahtabschnitts zu einer im allgemeinen U-Form umfasst, um gegenüberliegende Beine und einen bogenförmigen Zwischenbereich zwischen den Beinen bereitzustellen.
  14. Verfahren nach Anspruch 13, weiter aufweisend:
    Formen des Drahtsegments wobei der Zwischenbereich zwei geneigte Seitensektionen und eine gekrümmte Spitze zwischen den Seitensektionen aufweist.
  15. Verfahren nach Anspruch 10, worin:
    die Wicklung ein Miteinanderverflechten erster und zweiter Sätze entgegengesetzt gerichteter helixförmiger gewickelter Drähte aufweist.
  16. Verfahren nach Anspruch 10, worin:
    das Wickeln ein Formen der gestreckten Drähte in mehrere Zellen aufweist, die durch Draht-koextensive Bereiche verbunden sind, entlang welcher Paare der Drähte helixförmig umeinander gewickelt sind.
  17. Verfahren nach Anspruch 10, worin:
    das Koppeln ein Formen jedes Paars dazugehöriger Drahtkupplungen mit einem Draht einer ersten Kupplung des Paars einschließlich einer Drahtverlängerung mit vorbestimmter Länge aufweist, die sich axial auswärts über die verbleibenden Drähte des Kupplungspaars hinaus erstreckt; und
    beliebiges Formen der Drahtverlängerung, um einen bogenförmigen Bereich bereitzustellen, und um ein freies Ende der Verlängerung zur Verbindung mit der zweiten Drahtkupplung des Paars zu positionieren.
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US7655039B2 (en) 2010-02-02
CA2526382C (en) 2013-01-15
AU2004243014B2 (en) 2009-12-10
JP4791364B2 (ja) 2011-10-12
JP2007500065A (ja) 2007-01-11
DE602004032127D1 (de) 2011-05-19
US9788979B2 (en) 2017-10-17
CA2526382A1 (en) 2004-12-09
EP1628596A1 (de) 2006-03-01
WO2004105647A1 (en) 2004-12-09
US20140081382A1 (en) 2014-03-20
US20100161034A1 (en) 2010-06-24
US20050049682A1 (en) 2005-03-03
US20180021154A1 (en) 2018-01-25
EP2286771A1 (de) 2011-02-23
US10426643B2 (en) 2019-10-01
US20120101564A1 (en) 2012-04-26
EP2286771B1 (de) 2016-05-11
AU2004243014A1 (en) 2004-12-09
ATE504272T1 (de) 2011-04-15
US8109988B2 (en) 2012-02-07
ES2364555T3 (es) 2011-09-06

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